Hindsight is 20/10: Parker Edition, Part 2: Student Clinic

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The saga continues (find Part 1 here).  Tri 6 at Parker College is the big change-over from academic dominance into clinic practicum.  Since this is our first rodeo in terms of being responsible for real patients (partnering up in Tris 4 and 5 don’t really count, because it’s not like you had to go recruiting…and after all, that’s what the latter half of an education at Parker teaches you–recruiting).

Getting through clinic is no small feat, either.  There are few lifesaving gems that made it possible–er, easier.

* I wish I had known further in advance that we had to recruit our own patients for Student Clinic, too.  Since you’re caring for students and their dependent immediate families, you obviously aren’t responsible for new recruits, per se, but you do have to talk enough people into coming to see you in order to have a patient load sufficient to get you your passing numbers.  You can get through on a comfortable minimum of 4 patients, if they’re solid and reliable.  Six is average, and gives you a bit more breathing room.  Any more than 8 patients, though, and you almost start getting overwhelmed, unless they don’t need to come in very often.  So, start recruiting early.
* I wish I had scheduled more proactively.  Because of a few administrative failures to disperse information properly to the Tri 4s and 5s, they missed appointments they didn’t know had been made for them, and some of them are not good about checking voice mail or returning phone calls.  You have to get them done first, and then the Tri 1s, before you can even start seeing any of your own patients.  I wish I had pawned some of the flakier undertri students onto others who could still use an extra exam, so I would’ve been able to get to my own patients faster.  I made it through, but because I got such a late start adjusting, I had to make up for lost time during the 2nd half of the tri.
* I’m glad that despite the above, I did fare better than some of my peers in that I already knew how to “take charge” assertively, both in terms of scheduling people and keeping them current with their treatment plan.  The best thing you can do is schedule your next patient visit right there.  Do not let them “call you when they know their schedule” (aka “will-call” status), and don’t ask them, “when would you like to come in next?”  That leaves things too wide open, letting the inmates run the asylum, so to speak.  It undermines your authority as a doc; you can maintain this authority without coming off like a dick.  Even if your schedule is wide open, you offer them specific days, then ask if they’d like morning, afternoon, or evening, and then narrow it down to choices between specific times.
* I’m also glad I was already familiar with the concept of “cluster-booking”, meaning that you schedule patients back-to-back.  Start with your most reliable and most regular patients; give the first scheduling dibs to them.  Once those appointments are set, then you build the rest of your schedule around them.  It’s good to offer your last appointment of the day to your least reliable patient; this way, if they don’t show up, you at least get to leave early, instead of having to wait around for another patient after the no-show.  Heh, it’s probably not the most desirable time slot, but then, you’re talking about chronic unreliability here; if they’re not considerate and respectful of my time and schedule, then I tend to take theirs less seriously, in turn.
* I’m glad I used the checklists that get passed around – it’s good to record all the adjustments, exams, QAs, etc, and their dates and fee slip numbers all in one spot, so that you have all the info you need in case you need to reference it quickly later.  It’s also good to stay on top of your game – have a designated place for all your green sheets and leave them there – don’t carry a bunch of green sheets around with you, in case you lose your clinic notebook or backpack or water.  You need to keep your green sheets FOREVER, even after you get your license, because they are your only proof that you ever met your requirements.  Apparently your board scores, clinic checkout sheets, official transcripts, and diplomas are not sufficient.
* This part didn’t pertain to our class, but it’s relevant to every class after us: x-ray everyone you can in student clinic.  You need to do 15 x-ray writeups in order to graduate, and x-rays are much easier to take in student clinic (depending on your staff doc) than in outpatient, because x-rays through student clinic don’t cost your patient anything.  Note: you only have like a day or 2 to submit your report, so get it done right away.
* I wish someone had told me about the frequency of the emotional breakdowns: roughly twice a week.

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